Provider Demographics
NPI:1972949857
Name:KENDZIERSKI, CANDY SUE (LPN)
Entity Type:Individual
Prefix:
First Name:CANDY
Middle Name:SUE
Last Name:KENDZIERSKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 DEARBORN AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-1610
Mailing Address - Country:US
Mailing Address - Phone:419-481-4413
Mailing Address - Fax:
Practice Address - Street 1:223 DEARBORN AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-1610
Practice Address - Country:US
Practice Address - Phone:419-481-4413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.134529M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse